Provider Demographics
NPI:1962624213
Name:MINNESOTA HAVEN HOMES
Entity type:Organization
Organization Name:MINNESOTA HAVEN HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:SIA
Authorized Official - Middle Name:JAMILA
Authorized Official - Last Name:SOGBEH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-245-1658
Mailing Address - Street 1:8227 12 AVENUE S.
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55423
Mailing Address - Country:US
Mailing Address - Phone:612-245-1658
Mailing Address - Fax:651-207-6841
Practice Address - Street 1:8227 12 AVENUE S.
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55423
Practice Address - Country:US
Practice Address - Phone:612-245-1658
Practice Address - Fax:651-207-6841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR166070-8310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility